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Folkert J Ten Cate

Publications and source records attributed to Folkert J Ten Cate.

12 recordsLinked to original sources
PubMed2004

Myocardial wall thickness predicts recovery of contractile function after primary coronary intervention for acute myocardial infarction.

OBJECTIVES: We sought to determine whether end-diastolic wall thickness (EDWT) can predict recovery of regional left ventricular contractile function after percutaneous coronary intervention (PCI). BACKGROUND: Regional contractile function does not recover in all patients after PCI for acute myocardial infarction (AMI). Prediction of functional recovery after AMI may help in clinical decision making. METHODS: Forty consecutive patients with AMI were studied with left ventricular contrast echocardiography for accurate wall thickness and function measurement and myocardial perfusion immediately after and two months following PCI. RESULTS: Out of 640 segments, 175 (27%) dysfunctional segments in the infarct territory were analyzed for EDWT, wall function, and perfusion. One hundred and three (59%) dysfunctional segments presented with an EDWT <11 mm and 72 (41%) presented with an EDWT > or =11 mm. Perfusion (partial or complete) was present in 63 segments with an EDWT <11 mm (61%) and 71 segments with an EDWT > or =11 mm (99%) (p < 0.001). At two months' follow-up, 66 of 72 segments with an EDWT > or =11 mm (92%) improved, whereas only 35 of 103 of the dysfunctional segments with an EDWT <11 mm (34%) improved (p < 0.0001). CONCLUSIONS: Wall thickness is an easy parameter to predict recovery of function after revascularization. Moreover, combining EDWT and perfusion, segments with an EDWT > or =11 mm, and presence of perfusion have the highest chance of recovery; segments with an EDWT <11 mm and perfusion have an intermediate chance of recovery. In segments with an EDWT <11 mm and no perfusion, chances of recovery are very low.

Adult↗
PubMed2004

Permanent pacing for complete atrioventricular block after nonsurgical (alcohol) septal reduction in patients with obstructive hypertrophic cardiomyopathy.

Nonsurgical septal reduction is a newly developed, catheter-based therapeutic option for patients with drug-refractory obstructive hypertrophic cardiomyopathy. A circumscribed septal infarction is generated to reduce the left ventricular outflow tract gradient. The spontaneous regression of complete atrioventricular block after the procedure and the main complication of the intervention are examined, and treatment with permanent pacing is evaluated.

Cardiac Pacing, Artificial↗
PubMed2004

Diastolic coronary vascular reserve: a new index to detect changes in the coronary microcirculation in hypertrophic cardiomyopathy.

OBJECTIVES: The present study introduces a modification of the diastolic coronary conductance concept that maintains its sensitive properties to detect changes in the coronary microcirculation in human hypertrophy. BACKGROUND: Decrements of coronary flow in hypertrophy have been explained by changes in the coronary microcirculation. No measure is available to detect these changes. METHODS: Doppler velocity catheters were introduced into the left anterior descending artery (LAD) and left circumflex coronary artery (LCx) of patients with obstructive hypertrophic cardiomyopathy (HCM) (n = 11) and into the LAD of cardiac transplant recipients (n = 9). The diastolic coronary conductance was measured at rest and after maximal hyperemia induced by a bolus injection of adenosine. Diastolic coronary vasodilator reserve (DCVR) was calculated as the hyperemic diastolic coronary conductance, divided by the coronary conductance during resting conditions. RESULTS: Left ventricular outflow tract gradient in the HCM group (83 +/- 31 mm Hg) was significantly higher (p < 0.05). Septal wall thickness was significantly increased (p < 0.05), while wall thickness was unchanged in the posterior wall of the HCM group. The coronary flow reserve was significantly decreased in the HCM-LCx region (to 64 +/- 7% of control) and in the HCM-LAD regions (to 57 +/- 7% of control). The DCVR was only decreased in the HCM-LAD (to 46 +/- 3% of control) and not in the HCM-LCx group (86 +/- 6%, p > 0.05). Esmolol did affect the pressure gradient and systolic shortening, but did not affect the maximal diastolic conductance. CONCLUSIONS: The DCVR, in contrast with the coronary flow reserve, is decreased in those regions that display a disturbance in the microcirculation and may, therefore, offer a new way to study coronary adaptations in patients with hypertrophy.

Adenosine↗
PubMed2004

Guiding and optimization of resynchronization therapy with dynamic three-dimensional echocardiography and segmental volume--time curves: a feasibility study.

OBJECTIVE: To assess a new approach for guiding and hemodynamic optimization of resynchronization therapy, using three-dimensional (3D) transthoracic echocardiography. BACKGROUND: Resynchronization therapy for heart failure provides the greatest hemodynamic benefit when applied to the most delayed left ventricular (LV) site. Currently, the ideal LV pacing site is selected according to acute invasive hemodynamic assessment and/or tissue Doppler imaging. METHODS: A total of 16 patients with advanced heart failure and an implanted biventricular pacemaker were included in this study. Transthoracic apical LV images at equidistant intervals were obtained using a prototype, fast-rotating second harmonic transducer to reconstruct 3D LV datasets during sinus rhythm (SR), right ventricular (RV) apical and biventricular pacing mode. A semi-automated contour analysis system (4D LV analysis, TomTec, Germany) was used for segmental wall motion analysis and identification of the most delayed contracting segment and calculation of global LV function. RESULTS: Data acquisition duration was 10 s and analyzable 3D images were obtained in 12 patients. Of these patients, data during SR were available in 9 and during biventricular pacing in 11. The greatest contraction delay during SR was found in the anterior and antero-septal segments in five of nine patients. Biventricular pacing resulted in reduction of the contraction delay in seven of eight patients. The global LV function did not change significantly. CONCLUSION: 3D echocardiography with appropriate analytic software allows detection of the most delayed LV contracting segment and can be used to select the optimal pacing site during resynchronization therapy.

Aged↗
PubMed2003

Hypertrophic cardiomyopathy in a large community-based population: clinical outcome and identification of risk factors for sudden cardiac death and clinical deterioration.

OBJECTIVES: This study evaluates the clinical course and identifies risk factors for sudden cardiac death (SCD) and clinical deterioration in hypertrophic cardiomyopathy (HCM) in a large community-based population. Comparison was made with data from six tertiary referral and six nonreferral institutions. BACKGROUND: Hypertrophic cardiomyopathy is a disease with marked heterogeneity in clinical presentation and prognosis. Risk factors for SCD are not well defined in patients free of referral bias. METHODS: Between 1970 and 1999, 225 consecutive patients (mean age [+/-SD] 41+/-16 years) were examined and followed at yearly intervals. RESULTS: Forty-four deaths were recorded of which 27 cases were cardiovascular. Fourteen patients died suddenly, six were successfully resuscitated, and seven patients died of congestive heart failure. The annual mortality, annual cardiac mortality, and annual mortality due to sudden death were 1.3%, 0.8%, and 0.6%, respectively. At least one New York Heart Association (NYHA) functional class deterioration was reported in 33% of the patients with a significant (> or =50 mm Hg) left ventricular outflow tract (LVOT) gradient in contrast to 7% without obstruction. The presence of syncope was related to SCD (p < 0.05). Younger age and more severe functional limitation distinguishes patients from in hospital-based centers from the ones in community-based centers. CONCLUSIONS: Hypertrophic cardiomyopathy is a benign disease in an unselected population with a low incidence of cardiac death. Syncope was associated with a higher incidence of SCD and patients with a significant LVOT obstruction were more susceptible to clinical deterioration.

Adult↗
PubMed2003

Visualization of myocardial perfusion after percutaneous myocardial septal ablation for hypertrophic cardiomyopathy using superharmonic imaging.

Harmonic imaging is used for detection of ultrasound contrast agents in myocardial perfusion studies. However, harmonic imaging has limitations because of the presence of tissue harmonics, which results in less specificity and sensitivity, thus, lower contrast-to-tissue ratio. We describe a clinical example using superharmonic imaging. This technique detects the third, fourth, and fifth harmonics. These harmonics are not created in tissue, resulting, hence, in a high contrast-to-tissue ratio. After myocardial alcohol ablation for hypertrophic cardiomyopathy areas of nontreated and treated myocardium, normal and low flow could be visualized with superharmonic imaging.

Cardiomyopathy, Hypertrophic↗
PubMed2002

Contrast harmonic imaging.

The behavior of ultrasound contrast agents depends highly on the acoustic pressure of the insonified ultrasound wave. For low pressure the expansion and compression is linear to the pressure, for medium acoustic pressure nonlinear behavior starts to occur and for high pressures, but still in the diagnostic range transient scattering can be noticed, resulting in an enhanced scattering followed by a disappearance of the bubble. The nonlinear and transient regime can be utilized for imaging of the contrast agent in or nearby tissue. The magnitude of the nonlinear signal from the contrast has to compete with the nonlinear component of the ultrasound wave, which is generated during propagation. It is shown that contrast is superior to tissue when using low frequencies and imaging the third or fourth harmonic of the transmitted frequency.

Journal Article↗
PubMed2002

Improved contrast to tissue ratio at higher harmonics.

The challenge in ultrasound contrast imaging is a better discrimination between the perfused tissue and the contrast bubbles, which is usually expressed by contrast to tissue ratio (CTR). Imaging based on the second harmonic frequency showed a higher CTR than imaging at the fundamental frequency. However, because of nonlinear propagation of ultrasound waves, harmonic frequencies are generated. These harmonic frequencies will be linearly reflected by the tissue and therefore limit the CTR at the second harmonic frequency. In order to reduce the scattering of tissue at harmonic frequencies and by that increase the CTR, nonlinear distortion has to be reduced. We demonstrate in this study that the CTR increases with the harmonic number. The increase is substantial when transmitting at lower frequencies. To take advantage of the higher harmonics (third, fourth, fifth and the ultraharmonics and termed here super harmonics), we have developed a new phased array transducer with a wide frequency band. In-vitro measurements using the new probe show an increase of 40 dB of the CTR for super harmonic components over the conventional second harmonic system. The increase in CTR is in agreement with the calculations using existing models for the response of encapsulated bubbles and known theory of nonlinear propagation.

Journal Article↗
PubMed2002

Super harmonic imaging: a new imaging technique for improved contrast detection.

For ultrasound contrast agents (UCA), nonlinear imaging now has become fundamental. All of the current contrast-imaging methods are dominantly based on the nonlinear response of UCA bubbles. The discrimination between the perfused tissue and the UCA is the challenge in the field of UCA-imaging. This differentiation is usually associated or expressed by the ratio of the scattered power from the contrast agent to the scattered power from the tissue and is termed "contrast-to-tissue ratio" (CTR). Second harmonic imaging showed a better discrimination between tissue and UCA than fundamental imaging because of a higher CTR. We demonstrate, in this study, that the CTR increases as a function of the order of the harmonic frequency. Currently, due to the limited bandwidth of the transducers, only the second harmonic is selectively imaged, resulting in images with a superior quality to fundamental images, but still degraded and not optimal because of the harmonic generation in the underlying tissue (due to nonlinear propagation) and hence giving a limited CTR. To increase the CTR and to take advantage of the higher harmonics (third, fourth, fifth and the ultraharmonics and termed here super harmonics), we have developed a new phased array transducer. The array transducer contains two different types of elements arranged in an interleaved pattern (odd and even elements). The total number of elements is 96. The elements can operate separately and at a distinct frequency, enabling separate transmission and reception modes. The odd elements (48) operate at typically 2.8 MHz center frequency and 80% bandwidth. The even elements (48) have a center frequency of 900 kHz with a bandwidth of 50%. In vitro measurements using the dual frequency probe show an increase of 40 dB in the CTR for super harmonic components over the conventional second harmonic system. The increase in CTR is in agreement with the calculations using existing models for the response of encapsulated bubbles and known theory of nonlinear propagation. Animal experiments have demonstrated the feasibility of this approach using commercially available UCA and showed a similar increase of the CTR.

Contrast Media↗
PubMed2002

Usefulness of ultrasound contrast for image enhancement during stress echocardiography.

Although stress echocardiography has been established as a diagnostic technique for the detection and assessment of ischemia, there are still a number of limitations to the technique. These are related to suboptimal image quality with poor visualization of endocardial borders. Because assessment of wall motion is fundamental to the diagnostic value of stress echocardiography (both pharmacologic and exercise), endocardial border visualization is of utmost importance. Furthermore, interinstitutional observer agreement of 100% in highest image quality patients to a cumbersome 43% in low image quality patients is present. Therefore, improvements of image quality during stress are essential. One of the recent improvements is harmonic imaging, which improves visualization of endocardial borders at rest and during dobutamine stress. However, there is room for improvement. Since the introduction of ultrasound contrast agents, contrast has been increasingly used for better endocardial border visualization. Data from centers with a large number of stress echocardiography tests have shown that the addition of contrast agents decreases the number of more redundant diagnostic testing. Data obtained in our center in a subset of patients administered with SonoVue, a new generation contrast agent made of stabilized microbubbles containing sulfur hexafluoride, an inert gas, showed an improvement in the number of evaluable segments with fundamental and harmonic imaging and in the endocardial border detection during dobutamine stress echocardiography. Contrast also enables future quantitative analysis using acoustic quantification (AQ), and color kinesis. These studies should be carried out now that contrast has been approved for introduction to the market.

Echocardiography↗